Elderly struggle with surprise ambulance bills

In many cases someone else called 911, and elderly people say they were not expecting and can't afford the high bills

By Harold Brubaker
The Philadelphia Inquirer

PHILADELPHIA — Sometimes, a Good Samaritan turns out to be anything but.

That's how Delores Cantz feels about an episode in March, when the 82-year-old slipped and fell while dancing at a party in Warminster.

Cantz said that after the fall she got up and walked to a side room, where - to her surprise - a crew from the nonprofit Warminster Volunteer Ambulance Corps was waiting to evaluate her and take her to a local hospital.

She refused what she thought was an unneeded emergency-room visit.

The result was a surprising $500 bill from the ambulance company. That's more than Medicare would allow for an actual transport to the hospital.

Unexpected ambulance bills are just one of many financial pitfalls for the elderly on fixed incomes, which means an unexpected bill can be a hardship.

In Cantz's case, paying that $500 bill would eat up nearly half of a monthly Social Security check, which is all the Wissinoming resident lives on.

"I didn't think I was going to get charged at all because I didn't make the call," Cantz said Tuesday.

Cantz might have been better off financially if she hadn't turned down the trip to the hospital.

Then her Medicare Advantage plan likely would have paid part of the ambulance bill, plus hospital charges - an example of how financial incentives can steer people toward choices that cause higher overall spending in the health-care system.

Harry Freedman, 82, of East Falls, has a different problem with an ambulance bill, but he's just as upset as Cantz.

Freedman also had a fall in March. He tripped on a rug at an auto dealership on Roosevelt Boulevard in Northeast Philadelphia.

Someone called 911. He said he doesn't know who.

An ambulance from the Philadelphia Fire Department's Emergency Medical Services unit took him to Aria Health-Torresdale's emergency room, where he underwent tests.

What did surprise him was a $175 bill from the city for an ambulance co-pay. Insurance paid $264.

Freedman said if he had known about the co-pay, he never would have agreed to get into the ambulance. "All I needed was a little time to recuperate, and I could have driven myself to the hospital," he said.

"I'm a taxpayer. Why should I have to pay for an emergency service that I never even ordered?" Freedman wondered.

That's not the way it works, said a city official.

"Any police activity and fire protection, that's included in your tax dollars," said Capt. Peter Crespo of the Philadelphia Fire Department. "Medical services, we do bill for that," Crespo said.

As long as insurance money is available for emergency medical services, a municipality would be remiss if it didn't bill for those services because it would leave insurers with a windfall, said Douglas M. Wolfberg, a lawyer who specializes in emergency medical services.

But the notion that taxpayers such as Freedman deserve a break has been widely recognized.

"Many cities across the country waive those co-payments for someone who is a resident or a taxpayer in that jurisdiction," said Wolfberg a partner in Wolfberg & Wirth L.L.C., in Mechanicsburg, Pa.

Philadelphia waives co-pays only on a case-by-case basis, Crespo said. On the other hand, Philadelphia charges only $50 in the case of what it calls a "treat-no-transport," one tenth of the bill sent to Cantz by Warminster.

Chris McDonald, director of emergency medical services for the Warminster Volunteer Ambulance Corps, said situations like the one described by Cantz, where an ambulance isn't wanted, are not unusual.

"It's still time and money that our crews spent treating these patients, and we have to see some type of reimbursement," McDonald said.

Cantz said she can't afford the $500, but agreed to send $50 in a bid to save her credit rating.

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